MEDICARE: DEDICATED HOME CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1386451318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEDICATED HOME CARE LLC

Provider Business Mailing Address
First Line	:	8420 COUNTRY CLUB BLVD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46234-1848
Country	:	US
Telephone Number	:	317-523-8670
Fax Number	:

Provider Business Practice Location Address
First Line	:	8420 COUNTRY CLUB BLVD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46234-1848
Country	:	US
Telephone Number	:	317-523-8670
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TARA LEE LACY
Credential	:
Telephone Number	:	317-523-8670

Provider Enumeration Date	:	12/13/2024
Last Update Date	:	12/13/2024

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Directions to “DEDICATED HOME CARE LLC ” Practice Location

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